First report of a human autochthonous hepatitis E virus infection in Brazil

BackgroundSporadic acute hepatitis E cases occurring in non-endemic areas have been associated to genotypes 3 and 4 of hepatitis E virus. Several studies have demonstrated the relationship among human and animals strains, mostly pigs and deers, from respective areas characterizing zoonosis. Circulation of genotype 3 of HEV in Brazilian swine herds have already been demonstrated. Nevertheless, no confirmed human cases have been reported to date in Brazil.ObjectivesA study was developed to attempt the identification of hepatitis E acute cases in Brazil.Study designA retrospective study carried out with 64 serum samples from patients with acute non-A–C hepatitis was performed to identify human cases of acute hepatitis E.ResultsWe could identify a confirmed case of acute hepatitis E. The patient seroconverted to hepatitis E virus-specific IgM and IgG antibody, HEV-RNA was amplified from serum, and the analysis of the sequence of a 242 nucleotide fragment from the ORF1 genome region classified the strain within genotype 3 and subgenotype 3b. Investigation of risk factors and results from phylogenetic analysis suggested a likely zoonotic origin for the infection.ConclusionsThe first report of a human autochthonous in Brazil contributes with new information for hepatitis E epidemiology in Latin America and to considerate further broadly epidemiological studies.     

First detection of autochthonous Zika virus transmission in a HIV-infected patient in Rio de Janeiro,Brazil

Since May 2015, Brazil’s Ministry of Health has reported autochthonous transmission of Zika virus (ZIKV) in some states of the country. Simultaneous circulation of Dengue, Chikungunya and ZIKV in the country hinder both the diagnosis and the therapeutic approach of patients seeking care with acute febrile illnesses especially in patients with comorbidities. The association between HIV infection and endemic diseases has been described especially in tropical regions with varying levels of complications, although there has been no report of ZIKV in HIV-infected patients. We report the first autochthonous case of laboratory confirmed ZIKV infection in a HIV-infected patient in Rio de Janeiro, Brazil. He evolved with only mild symptoms and recovered well without major laboratory abnormalities. Phylogenetic analysis of the ZIKV detected in the patient sera clustered within the Asian clade. To the best of our knowledge, this is the first time that Zika virus co-infection is reported in a HIV-infected patient.     

First three reported cases of nosocomial fungemia caused by Candida auris

Candida auris is a newly described species whose clinical significance is not clear. Here, we describe the first three cases of nosocomial fungemia caused by C. auris, which confirms that it is a causative agent of bloodstream infections. All three patients presented persistent fungemia for 10 to 31 days. The isolates obtained from the three patients were misidentified as Candida haemulonii and Rhodotorula glutinis by the Vitek 2 and the API 20C systems, respectively. C. auris was confirmed by sequence analysis of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA of the rRNA gene. The MIC ranges of amphotericin B (AMB), fluconazole (FLU), itraconazole, and voriconazole were 0.5 to 1, 2 to 128, 0.125 to 2, and 0.06 to 1 μg/ml, respectively. All isolates were susceptible to caspofungin (MIC = 0.06 μg/ml) and micafungin (MIC = 0.03 μg/ml). One patient developed breakthrough fungemia while receiving FLU therapy, and two patients who received FLU therapy followed by AMB showed therapeutic failure and fatal outcomes. Our cases show that C. auris fungemia can be persistent, despite FLU or AMB therapy, which emphasizes the importance of accurately identifying this species.     

Adult meningitis caused by Hemophilus influenzae serotype f, biotype I

Meningitis and septicemia developed in an adult patient as a complication of otitis media. The rare etiologic agent responsible for the infection was identified as Hemophilus influenzae serotype f, biotype I. With appropriate therapy, complete recovery was achieved without complications or relapse.     

Federal spending for illness caused by the human immunodeficiency virus

Is the federal government devoting sufficient resources to fighting the epidemic of human immunodeficiency virus (HIV) infection, and are these resources being spent appropriately? Some observers contend that the amounts have been inadequate, but until now there has been no overall accounting of federal activities and spending to combat the epidemic. We report expenditure data collected from federal agencies for the years 1982 to 1989. In all, $5.5 billion will have been spent on HIV-related illness during this period by the federal government, nearly 60 percent of it by the U.S. Public Health Service. Federal spending on HIV-related illness in 1989 will reach $2.2 billion, representing over one third of all estimated national (public and private) HIV expenditures, and tripling state expenditures. In 1992, federal spending on the epidemic will reach an estimated $4.3 billion. Although sizable, this will be just 1.8 percent of all 1992 federal health dollars. Similarly, in 1992, national (public and private) spending on HIV-related illness will consume roughly 1.6 percent of all health-related costs in the United States. Federal spending for HIV research and prevention is similar to funding for other major diseases, including some conditions, such as cancer and heart disease, that now have a greater impact on mortality.     

Visceral lesions caused by Yersinia pseudotuberculosis,serotype II,in different species of bird

The size and distribution of histological lesions was studied in 14 cases of avian pseudotuberculosis using a combination of serotype-specific immunohistochemistry and image analysis. The material was derived from recent and archival cases in six canaries (Serinus canaria), two zebra finches (Poephila guttata), three psittaciformes (a kaka, Nestor meriondalis, one rainbow lorikeet, Trichoglossus mollucanus, and one budgerigar, Melopsittacus undulatus), and three New Zealand wood pigeons (Hemiphaga novaeseelandiae). The disease observed in the passerine species appeared to have an acute clinical course and the bacterial lesions were predominately enteric. In the pigeons and the psittaciformes examined, the clinical course of the disease was more chronic in nature and involved the liver and spleen. A correlation was found between the amount of stainable iron in the liver of affected birds and the area of bacterial lesions. All of the 11 strains of Yersinia pseudotuberculosis isolated from fresh necropsy material were serotype II, as determined using a standard serum agglutination test. Immunohistochemistry indicated the presence of antigen(s) common to serotype II in histological material from confirmed cases and in another three cases where the organism had been cultured but the serotype not specified. The in vitro virulence characteristics and plasmid profiles of Y. pseudotuberculosis isolates were also determined.     

ASC and NLRP3 impair host defense during lethal pneumonia caused by serotype 3 Streptococcus pneumoniae in mice

Streptococcus (S.) pneumoniae is the most common cause of community‐acquired pneumonia. The Nod‐like receptor family pyrin domain containing 3 (NLRP3) inflammasome, consisting of NLRP3, ASC (the adaptor apoptosis‐associated speck‐like protein containing a CARD) and caspase‐1, has been implicated in protective immunity during pneumonia induced by high doses of S. pneumoniae serotype 2. Here we investigated the role of the NLRP3 inflammasome in the host response during lethal airway infection with a low dose of serotype 3 S. pneumoniae. Mice were euthanized at predefined endpoints for analysis or observed in survival studies. In additional studies, Tlr2^?/?/Tlr4^?/? mice and Myd88^?/? mice incapable of Toll‐like receptor signaling were studied. In stark contrast with existing literature, both Nlrp3^?/? and Asc^?/? mice showed a strongly improved host defense, as reflected by a markedly reduced mortality rate accompanied by diminished bacterial growth and dissemination. Host defense was unaltered in Tlr2^?/?/Tlr4^?/? mice and Myd88^?/? mice. These results show that the NLRP3 inflammasome impairs host defense during lethal pneumonia caused by serotype 3 S. pneumoniae. Our findings challenge the current paradigm that proximal innate detection systems are indispensable for an adequate host immune response against bacteria.     

Bacteremia caused by Salmonella enterica serotype Choleraesuis in Taiwan.

Since 1995, there has been a steady increase in the number of reported cases of Salmonella enterica serotype Choleraesuis (S. Choleraesuis) sepsis in Taiwan. Representative Taiwanese survey data from 1996 to 2004 revealed that these adult patients with S. Choleraesuis bacteremia presented with primary bacteremia (57%, especially immunocompromised hosts), mycotic aneurysm (16%), and fever (86%) predominantly. S. Choleraesuis septicemia demonstrated a higher invasion index (with secondary involved sites) than other Salmonella spp. In swine experiments, the inoculation dose of 10(3) colony forming units S. Choleraesuis was cleared without apparent sequelae. Transmission of specific strains (with mutations of GyrA and parC, subsequently resistance to fluoroquinolones) from swine, and the acquisition of genes (CMY-2, AmpC complex) encoding beta-lactamases (with resistance to extended-spectrum cephalosporins) have been implicated in the evolution of multiresistant phenotypes of S. Choleraesuis. The virulence plasmid of S. Choleraesuis (pSCV), and other genes mediating adhesion to the epithelial cell membrane of the gastrointestinal tract, were considered important pathogenic factors for S. Choleraesuis. Vaccines for domestic animals combined with effective controls on antibiotic use offer the greatest potential to control the increasing impact of S. Choleraesuis on humans.     

2 Breton cases of autochthonous malaria, in reality the first French cases of "airport malaria"

Two cases of Plasmodium falciparum malaria encountered in Finistere in 1969 are regularly referred to in the literature as infections acquired in Brittany. In view of the extreme rarity of such an occurrence, it was decided to reexamine the data and consider in detail the biological and epidemiological factors for and against the possibility of infection occurring in Brittany.     

Multifocal granulomatous hepatitis caused by Actinobacillus pleuropneumoniae serotype 2 in slaughter pigs

In a survey of 66 894 slaughter pigs, 11 animals from three farms were found to have multifocal granulomatous lesions in the liver, caused by Actinobacillus pleuropneumoniae serotype 2. The lesions consisted of epithelioid cells and multinucleated giant cells, with asteroid bodies and discernible gram-negative bacteria. Lymph nodes and spleen were occasionally affected. The results suggested that haematogenous spread had occurred from pre-existing pulmonary infections.     

Individual cases of autochthonous malaria in Evros Province,northern Greece: entomological aspects

Prompted by four autochthonous cases of malaria in 1994 and 1995 in Evros Province, northern Greece, we conducted an entomological study between 1997 and 1999 in Nipsa and Chandras, rural locations where two of the four cases had occurred, and in Feres where two additional autochthonous malaria cases had been diagnosed in 1998. In Nipsa and Chandras, we identified 29 Anopheles breeding sites and characterized them by physicochemical parameters. Larvae were collected both at these sites and in a brackish water breeding site near Feres in the Evros River delta. Adults were caught in sheds at all three locations. Morphology was used to classify larvae and adults as A. superpictusor as species belonging to the A. claviger or A. maculipennis species complexes. The latter were further identified by PCR as being A. maculipennis s.s., A. melanoon and A. sacharovi. Of the A. maculipennis complex larvae collected inland, approximately 94% were A. maculipennis s.s. and 6% A. melanoon, whereas all larvae collected in the coastal region were A. sacharovi. In contrast, the A. maculipennis adults were A. maculipennis s.s. and A. melanoon (both 47%), and A. sacharovi (6%). In the coastal region, no A. maculipennis s.s. adults were caught. The ratio of A. melanoon adults collected to A. sacharovi was about 3:1. As shown by a bloodmeal ELISA, only 5 of 266 fed females (1.9%) had ingested human blood, whereas 232 (87%) had fed on goats. Of the mosquitoes containing human blood, two were A. melanoon, one A. sacharovi and one A. maculipennis s.s. One human blood specimen could no longer be assigned to a particular mosquito.     

Individual cases of autochthonous malaria in Evros Province, northern Greece: serological aspects

From 1994 to 1995 four presumably autochthonous malaria cases were diagnosed by blood smear microscopy in Evros Province, northern Greece. Alarmed by these unexpected infections a serological survey was performed from 1997 to 1999 in ten rural villages, including those where the malaria cases had occurred. Among the 1,102 blood samples examined, nine turned out to contain specific antibodies against plasmodial parasites as detected by indirect fluorescent antibody test, including two of the former patients. The remaining seven samples were taken from healthy individuals with no history of recent infection or of having travelled to endemic areas. A further 21 sera showed borderline reactivity with Plasmodium falciparum antigen. Although no retrospective examination of the blood specimens could be performed to confirm the serological results by direct parasite detection, we can conclude that at least the seropositive persons have actually undergone infection with malaria parasites but developed no or only mild clinical symptoms which went unnoticed. It is becoming obvious that even in European countries where climatic and vector conditions are favourable for the development of the parasite there is a potential risk of incidental malaria transmission by indigenous Anopheles mosquitoes.     

Cryptococcal meningitis caused by Cryptococcus neoformans var. gattii, serotype C, in AIDS patients in Soweto, South Africa.

We present four patients from South Africa with meningitis caused by Cryptococcus neoformans var. gattii, serotype C. These are the first patients with human immunodeficiency virus (HIV) infection to be reported with serotype C meningitis.     

First isolation of Cryptococcus neoformans var. gattii, serotype C, from the environment in Colombia.

The natural habitat of Cryptococcus neoformans var. gattii, serotype B in the environment was established by Australian investigators who demonstrated its association with species of Eucalyptus. The aim of the present study was to search for the habitat of this variety in a city of Colombia, where clinical cases due to this variety occur with great frequency. For a period of 5 months detritus, vegetable material and air samples in and around 68 almond trees (Terminalia catappa) located in the city were studied. C. neoformans var. gattii serotype C was the only variety isolated from two of the 68 trees sampled. These trees were positive for 4 of the 5 months during which they were studied. From the first positive sample kept under refrigeration, it was possible to isolate the fungus up to 3 months later. This is the first report of the isolation of serotype C from the environment. More studies are required in order to establish the ecological significance of this finding.